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Prognostic impact of extensive parenchymal invasion pattern in pT3 renal pelvic transitional cell carcinoma
Author(s) -
Yoshimura Koji,
Arai Yoichi,
Fujimoto Hiroyuki,
Nishiyama Hiroyuki,
Ogura Keiji,
Okino Takeshi,
Ogawa Osamu
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10609
Subject(s) - medicine , transitional cell carcinoma , lymphovascular invasion , hazard ratio , univariate analysis , lymph node , proportional hazards model , pathology , carcinoma , stage (stratigraphy) , clear cell , parenchyma , renal pelvis , renal cell carcinoma , clear cell carcinoma , urology , oncology , ureter , cancer , multivariate analysis , metastasis , bladder cancer , biology , confidence interval , paleontology
BACKGROUND Pathologic T3 renal pelvic transitional cell carcinoma exhibits various patterns of invasion. The authors investigated the prognostic impact of three patterns of invasion of pT3 renal pelvic transitional cell carcinoma. METHODS Of 212 patients who underwent surgery for renal pelvic transitional cell carcinoma, 70 with pT3 disease were eligible for the main analyses. The candidate predictors of prognosis included patient age, gender, lesion laterality, tumor grade, perioperative cisplatin‐based systemic chemotherapy, lymph node involvement, vascular involvement, and patterns of invasion. Invasion patterns were classified as fat invasion, ductal involvement, or parenchymal invasion. RESULTS Mean postoperative followup was 33.5 months (range, 1–136 months). On univariate analysis, gender, lymph node involvement, vascular involvement, and extensive parenchymal invasion each had a significant impact on the cause specific survival rate. A multivariate analysis using Cox stepwise regression revealed that extensive parenchymal involvement was the strongest prognostic predictor ( P = 0.0004, hazard ratio = 5.59). Lymph node involvement ( P = 0.0175, hazard ratio = 3.14) and gender ( P = 0.0361, hazard ratio = 2.42) were other weaker predictors. Statistically, pT3 disease without extensive parenchymal invasion had a prognosis similar to that of lower stage disease, and pT3 disease with extensive parenchymal invasion had a prognosis similar to that of pT4 disease. CONCLUSIONS Extensive parenchymal invasion has a strong prognostic impact in renal pelvic transitional cell carcinoma. pT3 disease should be subclassified into two separate entities, that with and that without extensive parenchymal invasion, in view of prognosis. Cancer 2002;94:3150–6. © 2002 American Cancer Society. DOI 10.1002/cncr.10609